Seretonin Syndrome Flashcards
What are the two main causes of serotonin syndrome (SS)?
- Medication
2. Neuroendocrine Tumours
What are the symptoms of serotonin syndrome?
Think of sympathetic agitation
- increased temperature
- agitation, insomnia
- increased reflexes
- increased HR
- myoclonus
- sweating
- dilated pupils
- diarrhoea
What are possible complications of SS? (2)
- Seizures
- Rhabdomyolysis
- Renal Failure
- Metabolic Acidosis
- DIC
What is the main cause in terms of medication? (2)
- Overdose
2. 2 or more serotenergic medications or drugs
What are the types of medications that can cause SS?
- SSRI
- SNRI
- MAOi
- TCAs
- Tramadol
- Odansertron
- Metoclopramide
- Cocaine
- MDMA
- Tryptans
How do you determine diagnosis?
- Medication History
2. Presenting History
Can a laboratory test confirm SS?
No
What is the treatment?
- Discontinuation of drug
- Benzodiazepine for agitation
- If consists use seretonin agonists - cryptoheptadine
Whats the clinical triad of symptoms for SS?
Cognitive Dysfunction - hypomania, mental confusion, hallucinations, coma
Autonomic Effects - shivering, sweating, hyperthermia, vasoconstriction, tachycardia, nausea, diarrhoea
Somatic Effects - myoclonus, hyperreflexia, tremor
What is the main cause of SS?
- Seretonin toxicity,
- increased serotonin in the CNS.
- increased affect on serotonin receptors
- Noradrenergic CNS hyperactivity occurs during SS
What is the DDx of SS?
- Neuroleptic Malignant Syndrome
- Anticholernergic Poisoning `
- Sympathomimetic Toxicity
How would you differentiate between NMS and SS?
NMS - bradykinesia, extrapyrimidal rigidity
SS - hyperkinesia and clonus
How would you treat agitation for SS?
- Benzodiazepine
How would you manage hyperthermia
- due to muscle over activity
- Requires sedation with benzodiazepines
- Severe cases require muscle relaxant - vecuronium and intubation
- Suxamethonium is contraindicated - cardiac dysarythmia from hyperkalaemia due to rhabdomyolysis
